It’s been said that “all would be well if there were no buts.” Unfortunately, for women there have always been several crucial “buts” about the benefits of mammography. Now, a new report from the American Cancer Society, says that routine mammograms may do harm if started before 50 years of age. So, what other “buts” don’t the American Cancer Society and other organizations tell women about mammograms?
Timing is vital, as is many things in life. But for years few experts could agree on the best time to start routine mammograms. The Canadian Association of Radiologists picked 40 years of age as prime time. The International Agency for Research on Cancer pulled age 50 out of the hat. In short, no one had a 100 per cent answer. Nor do I, as one would require the wisdom of Solomon to know.
But some facts are known, and the most vital one is never mentioned to women in any discussion about mammography. There’s a huge difference between diagnosing cervical cancer and breast cancer. That’s the reason more women survive cervical cancer than malignancies of the breast. And it’s unethical that it is never mentioned because it’s plain old-fashioned horse sense.
Luckily, the Pap test for cervical cancer examines mucus removed from the cervix, the lower part of the uterus, which is easily seen during a pelvic examination. Microscopic examination is then able to detect even pre-malignant cells or cells that are already cancerous.
Unfortunately, there’s no way to remove cells from inside the breast for microscopic testing. Doctors have to rely on mammography which cannot detect cells. Consequently, mammography is actually a “lump diagnosis.” Good sense tells you that it’s only when a lump becomes larger, that x-rays can detect it. Some experts say this requires several years. In the meantime, cancerous cells can spread to other parts of the body.
So, when the Cancer Society or any other organization states mammograms diagnose early cancer, it’s a deceptive remark. What they should say is that mammography diagnoses breast cancer as early as possible using X-rays. But it can never achieve the accuracy of the Pap test.
Those who fail to make this distinction will not be amused by this column, as my remarks are like damning motherhood and apple pie. They will argue that mammography does save lives and this is true, but the test also comes with questionable baggage.
For instance, mammography can result in many sleepless nights. The usual scenario is that a patient receives a telephone call stating a questionable area is present in the breast and further x-rays are required in an endeavour to rule out a malignancy. Or, a needle biopsy of the breast is required to obtain tissue that can be examined by a pathologist. And it is a rare institution that can quickly do these tests. So, of course, who wouldn’t worry, wondering if cancer is present.
The other problem is that mammography can result in a false sense of security when the test is reported normal. A few years ago, one report showed that in women between 40 to 49 years, mammography missed 30 per cent of malignancies.
Experts at that time agreed that whatever way you slice the cake the decrease in deaths as a result of mammography is modest. In effect, 2,000 women would have to be screened for 10 years to get one benefit. You can, of course, always argue that saving one life is worthwhile regardless of the cost.
Don’t forget radiation exposure. This problem is not only involved with the routine mammogram, but the additional ones required when a suspicious lesion is detected.
The World Health Association predicts that in the future two percent of all cancers will be due to excessive radiation. It’s not surprising when today many diagnostic tests rely on radiation.
Be an informed patient about mammography and discuss both pros and cons with your doctor.
